Perpetually Female, Perpetually Fatigued

Why are women so tired and what can be done about it?

Cindy Davis-Huffman has endured more than moments of fatigue. She nursed for 23 years in intensive care, among the high-stress, high-stakes environment of patients perched on death’s door. Between the ICU and her most recent second job as an organ donor nurse, she felt depleted, like a slow-leaking rubber life raft. With one child in grade school and the other in high school, the 44-year-old worked up to 50 hours per week in ICU and spent another 48 hours on call for her second job.

“I never thought of me, whether to sit down and read, take a nap or spend time with the kids or my husband,” she says. “I wasn’t ever doing that. How did I do all this stuff that happens — the carpooling, the driving to soccer games, laundry, dishes? You sleep when you can, get up exhausted, and do it all again the next day.”

“I didn’t realize how much we were spending on food,” she says, “probably $600 to $700 each month for garbage.”

You may know someone like Cindy. Or maybe you’re caught on fatigue’s molasses-coated treadmill. Surveys have shown women are three times more likely than men to report fatigue. Why are we so tired? And how do we fi x it?

MANY FACES OF EXHAUSTION

There are so many kinds of fatigue, you wonder if we shouldn’t have more words to describe exhaustion, much like Greeks classify different kinds of love and Eskimos identify variations of snow. There’s newbaby- tired; overworked-tired; poordiet- tired; caregiver-tired; chronic-illness- tired; diffi cult-relationship-tired; late-night-Facebook-tired…

Dr. Monica Blykowski-May, a family doctor at Rockwood Northpointe in Spokane, estimates 70 percent of women over age 30 complain of fatigue. She says most “textbook” diseases share fatigue as a symptom, making it tough to pinpoint a specifi c cause. She recommends a medical evaluation if you notice a signifi cant change in what you used to be able to do lasting more than a couple weeks: If you’re suddenly short of breath when exercising; if you’ve lost 10 pounds without trying.

Though actual chronic fatigue syndrome is rare, Blykowski-May says some fatigue-inducing conditions are fairly common — low thyroid hormone levels, diabetes and vitamin D defi ciency — and can be discovered through lab tests and managed with diet, exercise, medication and vitamins.

“Thyroid abnormalities are a common cause for fatigue,” says Spokane endocrinologist Lynn Kohlmeier, noting that almost 10 percent of the population has thyroid dysfunction. “Thyroid treatment, when needed, should be carefully regulated by your primary care provider.”

All symptoms related to thyroid dysfunction, including fatigue, usually resolve when thyroid levels are normalized. “When people feel tired, they sometimes consider supplements before having tests to try and explain their symptoms. If a supplement claims to provide ‘thyroid support’, it should be avoided,” Kohlmeier stresses. “These supplements can contain iodine, which has unpredictable effects on thyroid function.”

Anemia, a condition in which there are not enough healthy red blood cells to provide oxygen to the body, also causes fatigue. Often it is related to iron-defi ciency. Recent studies have shown one in five women to be anemic; half of pregnant women also have low stores of iron. Anemia can also be caused by other nutritional deficiencies or poor absorption of nutrients, or by diseases affecting the production and maintenance of red blood cells.

Vitamin D deficiency is another energy-killer, and for most people supplements are necessary to maintain optimal levels. Kohlmeier recommends at least 800IU of vitamin D3 daily. “Vitamin D defi ciency might not directly cause fatigue,” she says, “but it is very common and results in muscle weakness and arthritis-like symptoms, which contribute to feeling tired.”

NORMAL, BUT STILL EXHAUSTED

What if your lab work seems just fi ne? Sometimes fatigue is the result of a sleep problem, which can be diagnosed in a sleep study, but it may simply be a result of not getting enough sleep.

“That means nothing’s going to show up on a test,” says Blykowski-May, “and there’s no true sleep disorder. It’s a frustrating thing for women. It’s normal, but there’s no easy answer. You come home from the offi ce and want to roll into a ball… sick child, financial pressures, maybe you’re fat, tired, overwhelmed. That can’t be fixed with medication.”

Sometimes even when exhausted women make time to sleep, it can be elusive.

“It’s difficult to get a good sleep rhythm going. Lots of people are overworked, overstressed, oversaturated,” says Ellin Ethington, a clinical psychologist with Spokane’s Northwest Neurobehavioral Institute. “If that’s a chronic situation, eventually people’s ability to sustain that level of intensity diminishes. It compromises their energy.”

Ethington says overstimulation is one of our greatest stressors. We stare at screens — computers, cell phones, TV — seven days a week. We never unplug. When’s the last time you just stared up at the clouds? Switched off your mental to-do list?

That’s key for women spinning at the center of life’s carousel. We work, nurture children and aging parents, tend homes and communities. Like Marge Simpson of cartoon fame, we scrub one last dish before fleeing a burning house. Ethington advises moving your body long before the figurative fire fries your brain.

“One of best things is exercise,” says Ethington. “That’s counterintuitive: ‘If I’m so tired, how do I get the energy to walk around the block?’” But she says the effort will pay off.

In addition, “Turn off the computer at 8 o’clock instead of 9 o’clock, turn down the lights at that time, instead of turning them off at 10:30 and thinking, ‘Okay, I’m gonna sleep now.’”

Be patient. Ethington says it takes weeks or months to make new habits stick, so don’t give up if you fail to see results after a week of unplugging early and going to bed.

ENERGIZING FOOD CHOICES

Diet makes a difference, too. Leslie Hebert, a 30- year-old marketing director with Gonzaga University, says changing her diet has changed her life. Hebert’s energy level had been fl agging for years. She sought answers after tests at her doctor’s offi ce proved inconclusive.

“They weren’t really concerned about it,” she says, “but I was miserable and would have spells where I was throwing up. I got sick and tired of being tired. I was talking about it with someone at work and he said, ‘Have you ever thought about allergy testing?’”

Hebert learned she had a soy allergy, then found out nearly everything she was eating contained soy by-products (used as a thickener), like salad dressing, chocolate, chewing gum and tea. The married mom of a 14-month-old says she was able to work, fi nish graduate school and have her daughter all at once, thanks to banning soy four years ago.

“I feel a lot better. I’ve made almost a 100 percent recovery. I never would’ve thought the food you eat would make you feel this way.”

Even for people without a food allergy or sensitivity, though, diet can make the difference between feeling pooped and feeling invigorated. Dietitian Linette Giesa, a certifi ed diabetes educator based at Sacred Heart Medical Center in Spokane, says three common causes of fatigue are skipped meals, dehydration and alcohol. For women, Giesa says anything more than one drink a day can make you tired. So can thirst. “Often we’re fatigued because we’re dehydrated, especially in the afternoon. When that afternoon slump hits, drinking a big glass of water will help that fatigue. Thirst is often masked as hunger. We think we’re hungry when we’re actually thirsty.”

In spite of the almost overwhelming urge to grab a candy bar to boost energy, Giesa says sugar in general promotes lethargy. Instead, try eating complex carbohydrates like whole grains, legumes, fruits and vegetables to feel energized.

“They have nutrients that fuel our muscles and our brain,” she says. But she notes chronic, overwhelming fatigue may also arise from a medical condition: high blood sugar in diabetics causes fatigue, as does gluten for people with Celiac disease.

FINDING WAYS TO COPE

For some, fatigue is just a fact of life. Sixty-threeyear- old Carol Schmauder has multiple medical conditions, including Parkinson’s, an autoimmune disorder called Behcets Syndrome (pronounced buh-SHETS) and fi bromyalgia. She also has a heart condition.

“I get out of bed tired, and go to bed exhausted,” says Schmauder. “But I go about my business.”

While she limits sugar and manages her illnesses with immunosuppressive drugs, Prednisone and doses of compassion from her husband and friends, she says fatigue is hard for others to understand.

“I think there’s definitely a perception it’s not serious among those who don’t suffer from fatigue. Often people tend to think you could do something to make that better. Frankly, I don’t find a lot of things that make it better.”

Schmauder gets limited relief with pool exercise, careful attention to her diet and from something a little unexpected: exercising her creativity by making jewelry. She offers advice for others suffering extreme fatigue. “Find something that brings you joy in life, and at least do some of that every day.”

Blykowski-May suggests that when there doesn’t seem to be a fix for fatigue, fi nding someone to talk to can help. “Chronic fatigue has an effect on health and well-being, and counseling can be a signifi cant support… it may not fi x the underlying cause, but it helps people in what they can do.”

What works for Cindy Davis-Huffman is working less: After 23 years holding two nursing positions, she quit her second job and left intensive care. She now works at Sacred Heart Medical Center as a clinical documentation specialist. It’s a 40-hour-per-week gig. (“No more, no less,” she says of her new job.) Davis-Huffman can help her kids with homework, attend soccer games and prepare meals. She says extra money would be nice, but she won’t trade cash for quality of life.

“I’m a totally different person,” she says. “The kids will say, ‘You’re a lot less stressed; there are fewer wrinkles on your head.’ Life is way too short… I can’t get back those years when I was going so fast. I don’t know what I missed.”

TOP 5 CAUSES OF FATIGUE

THYROID DYSFUNCTION: Levels of thyroid hormone that are too high or too low can cause fatigue.

SLEEP: Sleep apnea and other conditions may mean you are not sleeping as well as you think you are; a sleep study can diagnose these conditions.